Hepatitis B virus in HIV-infected patients in north-eastern South Africa: Prevalence, exposure, protection and response to HAART

Abstract

Objective. Hepatitis B virus (HBV) and HIV are endemic infections in many African countries. The objectives of this study were to determine the levels of exposure to, and protection from, HBV, as well as the prevalence of HIV/HBV co-infection and the response of HBV to highly active anti-retroviral therapy (HAART) in a cross-section of HIV-infected patients in north-eastern South Africa. Study design. This was a laboratory-based, unmatched study. Three hundred and eighty patients were screened by ELISA for HBsAg, anti-HBc and anti-HBs. Samples non-reactive for HBsAg but reactive for anti-HBc were examined for occult HBV infection. Response to HAART was assessed by measuring HBV viral loads, seroconversion from HBeAg to anti-HBe, and levels of aminotransferase. Results. Of the study population of 380, 60% (95% CI 54.8 -64.9) were exposed to HBV based on HBsAg, anti-HBs or anti-HBc; 20% (95% CI 16.1 -24.4) had active HBV infection, based on HBsAg serology, and 30% (95% CI 25.2 -35.2) were protected, based on anti-HBs levels ≥10 IU/l. Of 181 HBsAg-negative individuals, 61 had HBV occult infection (33.7%, 95% CI 26.9 -41.1). The differences in prevalence were not statistically significant when gender, marital status and CD4+ cell counts were considered. Of 21 patients analysed, 80% showed adequate response to the first-line HAART regimen (stavudine/lamivudine/efavirenz or nevirapine) after 12 months of use. Conclusion. The study confirms the higher level (60%) of exposure to HBV in HIV patients in Limpopo Province, as well as the high (20%) prevalence of HBsAg positivity and occult hepatitis B (33.7%). However, further studies are warranted to corroborate the benefit of lamivudine-containing HAART regimens, as HIV/HBV co-infected patients have a higher liver-related mortality if hepatitis B is not treated.

Hepatitis B virus infection in post-vaccination South Africa: Occult HBV infection and circulating surface gene variants

“…The majority of South African studies on OBI have been conducted in HIV infected populations in whom the prevalence of OBI has been shown to range from 22.1% to 88.4% [3–5,11,25,28]. With OBI prevalence rates of 63.6% and 91.7% in the HIV positive subset of the PRVP and POVP respectively, this study reiterates the fact that HIV positive individuals are at high risk for OBI and OBI reactivation in South Africa, even after the introduction of universal hepatitis B vaccination.…”

Hepatitis B and HIV co-infection in pregnant women: Indication for routine antenatal hepatitis B virus screening in a high HIV prevalence setting

“…The rate of occult HBV infection in HIV-infected individuals is estimated to be 33%. [17] Testing for occult HBV infection could not be performed in our retrospective analysis owing to inadequate specimen volume for hepatitis B core antibody testing and confirmatory molecular testing. However, the unknown clinical significance of occult HBV infection, particularly its role in HBV transmission, together with the high cost of HBV molecular screening for an accurate diagnosis, means that it is unlikely to be included in a public health policy.…”

Hepatitis B sero-prevalence in children under 15 years of age in South Africa using residual samples from community-based febrile rash surveillance

“…In 2012, HIV prevalence in South Africa was estimated at 12.2% overall, with prevalence of 2.4% in children 2–14 years [18]. In studies published since 2000, HBsAg prevalence in South African adults living with HIV has been reported as 0.4–9.4% in HIV clinics [19–28] and up to 22.9% using hospital-based residual sera [29–31]. In antenatal clinics, rates of HBsAg in pregnant women ranged from 0.4–5.8% in HIV-uninfected women and 2.1–7.4% in HIV-infected women [32–35].…”